The NHS backlog

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Published 24 July 2020

No one that needs surgery should wait longer than 18 weeks after being referred by a GP. Unfortunately many do “breach” 18-weeks, which was met ~83% of the time pre-Covid-19. The next reporting milestone for anyone that goes past 18-weeks is 52-weeks (!). Reassuringly, this was “only” breached by 0.04% of people on the waiting list pre-Covid-19 (1,613 people).

There really shouldn’t be anyone getting close to waiting 52 weeks for an operation that is needed, so it is alarming how rapidly the number of people waiting more than 52 weeks has increased (see chart below) – from 1,613 in Feb to 3,097 in March, 11,042 in April and now 26,029 in May (x16). 

When performance measures become performance targets, it is a problem – they change behaviour. People waiting up to 18 weeks get progressively more urgent but disappear somewhat after they hit that target – we see them again when they hit 52 weeks. 

There are some immediate challenges post-Covid-19: the visible (and invisible) backlog, reduced productivity from infection control, and how to get activity levels back to pre-Covid-19 levels. It is hard enough to understand the scale of these challenges – it is even harder then to get on top of delivery. 

But, a big remaining problem is how waiting lists are set up and managed generally. This is especially true now that there are guidelines for prioritising surgery – these are essential in the short-run, but risk becoming rationing in the longer run.